
New York State Department of Health Division of Home and Community Based Services RRDS ADDENDUM REVIEW FORM HOME AND COMMUNITY BASED SERVICES MEDICAID WAIVER Nursing Home Transition and Diversion.
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How to fill out the Hcss Nhtd Waiver Isr And Dgp Templates online
Filling out the Hcss Nhtd Waiver Isr And Dgp Templates online is a crucial step for participants seeking Medicaid waiver services. This guide provides clear, step-by-step instructions to help users navigate the form accurately and efficiently.
Follow the steps to successfully complete your form online.
- Click the ‘Get Form’ button to obtain the Hcss Nhtd Waiver Isr And Dgp Templates and access it online.
- Begin by entering the date at the top of the form, followed by the participant’s name, CIN, and region. Ensure all details are accurate.
- Fill in the Service Coordination (SC) agency and SC coordinator name in the designated fields.
- Provide the current service plan period by indicating the start and end dates accurately.
- Select the status of the form from the options: received, approved, denied, withdrawn, or corrections needed. This gives clarity on the form's journey.
- Document if the addendum has been received by the RRDS and the relevant dates.
- Ensure that the participant or their legal guardian has signed and dated the addendum; also, the SC or SC supervisor should sign and date accordingly.
- If any corrections are needed, make note of the return dates to the SC and ensure the corrected version is acknowledged by the RRDS.
- Complete the submission section for QMS if applicable, including any dates related to over $300/day submissions and consultations.
- Check the attachments needed: signed and completed functional assessment, revised waiver contact list, insurance forms, and provider selection forms.
- For each section, indicate yes, no, or N/A for the ISP completion and provide comments if applicable. Pay particular attention to the specifics, as detailed guidance on service plans and costs is crucial.
- After reviewing all sections for completeness, users can save their changes, download the document as needed, or print directly for submission.
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